Addiction therapist Brian Carberg discusses the best ways to set boundar...
“Look for the Similarities, Not the Differences:” Psychiatric and Substance Use Disorders
No one wants to have a diagnosis of a psychiatric or substance use disorder, or both. The need for treatment is often difficult to acknowledge. Therefore, most people enter treatment and look for the differences between themselves and the others in treatment instead of their similarities. “Look for the similarities, not the differences” is a popular slogan in the 12-step Program.
A person focusing on the differences may say, “I’m not like that person,” or “I’ve never had that happen to me,” or “No one understands, my problem is different.” No one ever grows up thinking, “I’m going to work really hard. Someday I’ll be able to go to treatment with a group of people I don’t know and share my problems and most personal thoughts, feelings, and fears. I will identify myself as a person with a psychiatric or substance use disorder or both and change lots of things about myself. Then I will join a group I have always hoped to be a member of…the wonderful fellowship of Alcoholics Anonymous, Narcotics Anonymous, or Dual Recovery Anonymous!”
Sounds kind of ridiculous, doesn’t it? No wonder people look for the differences instead of the similarities. Looking at the differences means a person is looking for a loophole, so they’ll have a reason why they don’t fit with a diagnosis, don’t need treatment, and really don’t need to attend any 12-step groups. W.C. Fields was a famous comic actor who died in 1946. His friends knew he did not believe in a Higher Power or the Bible. That is why they were surprised to find him reading the Bible as he was dying. When a friend asked Fields what he was doing he responded with, “Looking for the loophole, my boy, looking for the loophole (Waldrep, 2002).” Even though it is common and understandable to look for loopholes or differences, there are more similarities among people with psychiatric and substance use disorders than differences.
How Are Psychiatric and Substance Disorders Similar?
Psychiatric and substance use disorders have many traits in common. One similarity is that they are both no-fault illnesses. This means that the person who struggles with them does not choose these illnesses and is not at fault for having them. Most people gain a greater level of self-acceptance by recognizing that they did not choose or desire this condition. Self-acceptance allows a person to rise out of self-blame, take responsibility for recovery, and start on the road to stabilization and wellness.
A second similarity between psychiatric disorders and addiction is that both are stigmatized illnesses. History is full of stories about people being shunned or disgraced because they had certain illnesses. Imagine having epilepsy during the Middle Ages. Misinformation would have resulted in the false belief that you were “possessed.” You would not only have struggled with your illness, but you would have carried the stigma or shame put on you by others. Society has mistakenly stigmatized psychiatric and substance use disorders. Fortunately, the acceptance of these disorders is now greater than ever before. Millions of people are in recovery or support loved ones in recovery. This helps replace old prejudices with accurate information.
A third trait that psychiatric and substance use disorders have in common is that they are illnesses of isolation. It is understandable for people to keep troubling thoughts, emotions, and behaviors private. Unfortunately, this leads to isolation and feelings of being alone. Many people feel they are the only ones who are experiencing the uncomfortable, unmanageable, or frightening thought patterns and emotions that accompany these disorders.
A forth similarity is that both disorders are brain disorders. There is mounting evidence that disturbances in the brain chemistry form the biological basis for the disease of addiction and psychiatric disorders like depression, anxiety, and bipolar disorder.
Furthermore, both disorders are chronic illnesses. Psychiatric and substance use disorders are lingering and persistent. These disorders share many other common characteristics like biological foundations, tendency to be inherited, the potential for denial, progressive deterioration, relapse, associated shame and guilt, and being incurable yet responding well to treatment. Each illness also fits into a disease-and-recovery model for assessment and treatment. The goal of treatment is to stabilize acute symptoms and encourage people to continue with a long-term program of recovery.
Finally, both illnesses have parallel phases of treatment and recovery that include acute stabilization, engagement in treatment, and prolonged maintenance. In each one of these categories, psychiatric and substance use disorder symptoms influence each other, overlap, or inter-link. They key that unlocks the confusion is dual recovery. This means a treatment approach that addresses both mental health symptoms and the goal of abstinence or harm reduction.
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